Nasty Box

Spontaneously, at 6:40 this morning, music just started coming from this strange box next to my bed. What is that box and who put it there? The worst part is the nasty box woke me up!!! What's up with that?

This is the first time in longer than I can remember where the alarm clock has actually woken me up. My previous pattern was I would set the alarm clock, and wake-up 1-2 minutes before it actually turned itself on. My internal body clock had always known what time it was, regardless of time zone and the alarm was just a back-up.

I managed about 9 hours of sleep last night (5 straight, then woke up a few more random times, taking Ibuprofen and Tylenol at 4:00 a.m.) and (complaint warning:) woke exhausted with a headache . Only sleeping 4 hours the previous night as well as the chin pain may have contributed to not feeling rested today. However, the chin pain seems continues to improve, even if just a little.

First Day Back

As I've blogged earlier, I absolutely love my job. In fact, I was so excited about my first day back at work, I woke up at 2:30 a.m. By 5:00 a.m., more sleep wasn't in the cards, so it was back to the grind. My plan is to work about half-time this week. For those of you that haven't experienced a Silicon Valley start up, half-time is about 8 hours a day...

I also had a scheduled visit to the surgeon today. Here's the medical update:

1. Arch bars come out Thursday (66 hours to go) - need I say more
2. The Neurontin seems to reduce the sharpness of the chin pain
3. All the stitches in my mouth are GONE. Since I never saw them, you have to wonder where they all went

Success - No Nap

Made it through the concert without a nap.

In fact, after the concert, Deb even pointed out that this is the first concert I've attended without a nap. In fact, I've been known to be snoozing before the first measure of the first piece.

Let's hope work goes well tomorrow... I'm going to put in half days for the coming week.

What's Left?

My son's orchestra performs this afternoon. The concert will be an unofficial test to evaluate the surgical success. I have yet to attend one of his afternoon concerts - 3 a year for the past 4 years - without falling asleep. In all fairness, I still take afternoon naps, and the concert takes place shortly after nap time. Yesterday's nap - only 20 minutes - spontaneously occurred watching the movie Doubt. Deb says that the part I missed was a bit slow.

As the recovery progresses, there are a few remaining effects of the surgery that need to resolve:

1. Chin pain - 6 on a scale of 10. Definitely improving.
2. Tight feeling on teeth at the gum line - feels like childhood braces were tightened. Likely due to arch bars
3. Grumpy, cranky, short tempered, impatient - personality flaws that existed prior to surgery - the surgeon would not agree to address these items
4. Numb lower lip and chin - common effect of surgery as are the remaining items on this list
5. Numb roof of mouth
6. No sensation in teeth - others have described this a wooden tooth feeling

If all goes well, the arch bars come off this week. My hope is that the arch bars are the root cause of the chin pain and the tight feeling at the gum line. Once these two sensations go away, I expect to be completely pain free and life will be good. Maybe #3 will change too. Soon I'll be saying "GREAT and I feel rested!"

If there would be an item 7 on the list above, it's shaving. Using a razor blade to scrape a chin with no sensation really scares me. So far, I've been lucky and it's worked out OK. So why not use an electric razor? Good question. I've actually tried one, and the added pressure from using the electric razor was uncomfortable on both my chin and near the mandible sites that were extended.

How Did You Sleep?

That seems to be the most common question I'm asked. In fact, the surgeon asks the question regularly as well.

One of these days, the answer is going to be "GREAT and I feel rested." We're not quite to that point yet. The biggest change is I'm now sleeping about 8.5 hours a night which is a HUGE increase from the 4-6 hours pre-surgery. Last night I had an uninterrupted 6.5 hour sleep run but woke up with the chin as active as ever. I took Tylenol and ibuprofen and slept on and off for another 2 hours. (3.5 hours of clock time elapsed - it took me about an hour and a half to fall back to sleep.)

I have a couple of ideas on what's preventing my getting restful sleep:

1. The strong and sharp chin pain disturbs my sleep
2. My sleep debt is so significant, it will take longer to payoff than my mortgage

Given that I have a lower AHI number than many patients who typically have this surgery, the best indicator of success will be my sleep quality and how I feel the next day. For people with severe sleep apnea and a high AHI number, success is typically measured by reducing the AHI number 50%. For someone with an AHI of 80 to go to 40, would be considered a success. From what I have read, many of the people with the 80 AHI actually end up w/AHIs of 10 or less, so they notice significant changes.

I've always been a very light sleeper. One theory, not proven medically, is that my central nervous system is very sensitive to external stimulus when sleeping, whether that stimulus is chin pain, appnea, hypopnea, or as seen in my many sleep studies, an "unexplained arrousal (sleep studies have measured 15-30 per hour in addition to appnea or hypopnea events). I believe that these unexplained arrousals are really appneas or hypopneas that aren't long enough to "officially" count as a respiratory sleep event.

So now that we've likely eliminated all the apneas, hypopneas, and unexplained arrousals, the only thing left of the list is the chin pain. Hopefully that will be gone in a few days, and I'll wake up like everyone else - well rested.

Questions Tell All

Earlier today, Deb asked if my weight had stabilized. Since I regularly update this blog with comments on my weight, it's quite apparent who reads the blog regularly. Not being able to answer her question with a simple answer as I had been doing immediately post-MMA, I reverted back to my old ways and I responded to her question with a question of my own. Perhaps the surgery has altered my appearance, but it still has not removed the character flaws from before.

Note to Deb (when/if you eventually read this): You are the most wonderful and amazing spouse. I am very luck to have married such and wonderful wife.

Nice People

I returned to the surgeon's office this morning for my scheduled visit. He readjusted some of the rubber bands and checked on the progress with the chin pain. While it's too soon for the Neurontin to kick-in, he's wants to ensure that the pain does not increase - which it hasn't. As the chin pain goes away, I will transition from the opiates -Percocet, Vicodin, and Tylenol w/codeine - to Neurontin over the next few days.

While waiting for my appointment, I met some very nice people. First, there was an infamous MMA blogger (recognizable from his pictures), just sitting in his chair waiting for his appointment as if he were a mere mortal. We had the opportunity to chat and share stories about our experiences. In many ways, we followed the same path - consultations with the amazing Stanford sleep doc, xPAP, tonsillectomy, oral appliance (same orthodontist), xPAP & oral appliance, then MMA. He mentioned that he will be looking into relaxation techniques and meditation. It might be worth a shot to check into that as well, as I've been known to be quite a "high strung" person. (In another Blog, I'll comment on my Transcendental Meditation exploration from about ten years ago),

Also waiting was a family with a teenage son who were considering jaw surgery. Hopefully they found resources like sleepnet.com and other blogs to provide them with more information from both the medical and patient point of view.

Finally, there was a patient who came in on her way home from the hospital. We did not strike up a conversation as she only stayed in the waiting room for a few minutes, and as I vividly remember, from my visit on the way home 20 days ago, all I wanted was to get home. Meeting other nice people in waiting rooms was not a priority 2 days post op. I wish her a speedy recovery.

Another Approach

The pain in my chin continues. The surgeon saw me for an unplanned visit this afternoon, took an Xray, and completed a thorough exam. Everything looked normal - which is very good; it's also a bit disappointing (in a very strange way) because there was nothing that could easily be fixed. He changed the rubber bands and evaluated my bite which "was as good as it was before the procedure." There are no plans to make make the bite better...

As a next step, the doc has prescribed Neurontin - a medication to control nerve pain. When the jaw gets moved, many of the nerves in the face get disturbed and these nerves need to reconnect as part of the recovery. For some people this can be a very painful experience - I may be one of those people.

My weight remains stable and my diet consistent. I'm still enjoying the daily walks. At this point, the walk is about 60-90 minutes through the hills of my neighborhood. It's not quite the same as climbing on a bike, but I'm glad be able to exercise.

First Book

I just finished John Grisham's The Associate. While I'm not going to offer a review, I will say that finding a book where I could pretty much turn the pages was relaxing and provided a great distraction from the discomfort.

Today is a definite improvement in comfort over yesterday. While there is still a long way to go, I'm getting more optimistic about this whole adventure shifting from the present to the past.

No major changes in diet other than I had scrambled eggs with cheese for breakfast. Eggs fit into that category of not requiring any chewing, yet flavorful with the added cheese.

Burrito vs. MMA Patient-Round 2

MMA Patient WON!!!

Eating the low carb way without the tortilla helped.

______________

Not Even Tempted

My son has become quite a good chef - he's 15. When he expresses interest in cooking and baking, we always encourage him. Last night, he decided to make cinnamon rolls for breakfast.

The rolls just came out of the oven, and the smell is overpowering. Remember the last time you walked past the Cinnabon store and just had to have one? Our kitchen smells GREAT!

Oddly enough, those yummy sweet rolls don't appeal to me. One of the strange things is that I have not had an appetite or interest in most foods. While I'm eating quite a bit, my weight continues to drop. I'm down to 158 pounds (total lost: 14).

Here's a typical day in my food intake:

• Breakfast: 1 or 2 Carnation instant breakfasts with whole milk or glass of soy milk with protein powder


• Morning Snack: 8 Oz yogurt mixed with berries and fruit juice (sometimes with protein powder added)


• Lunch: Meat based soup, thinned with broth (about 20 Ounces)


• Afternoon Snack: Yogurt Smoothie, same as morning


• Dinner: Vegetable soup AND meat based soup (24-30 ounces total)


• Plenty of water and other fluids during the day

The pain in my chin has improved only slightly. I'm continuing with the pain meds, but I can't say that I'm thrilled about staying on them. The challenge is that I'm more motivated without the pain meds, but more comfortable with them.

Walk, Hike or Both

In order to increase my energy level, I've felt like I've needed to increase my activity level. For the past couple of days, I've taken a walk that's about 1.2 miles around the neighborhood. Yesterday was no exception. I woke up and went for a walk.

A few hours later, my friend called and asked if I was up for a walk. We took a 90 minute hike on the trails near my home. It was GREAT to be outdoors. After the walk, I felt fine, and was not too exhausted. It' still a real challenge in that I would like to be engaged in conversation, but since speaking causes more pain, I've been in listening mode.

Like many others at this point in the recovery, I'm still very uncomfortable, but feel like I need to be doing something. Something needs to be a mindless activity since concentrating for long periods of time is still a challenge (movies still require too long a period of concentration). Today's mindless activity was a trip Costco. We had to have a tire fixed and my son joined me for the adventure. Since I drove, I did not take the pain killers before leaving. Fortunately, the gods of the tire center were able to complete their work quicker than planned, and we returned home safely after three hours. Immediately on our return, I took the pain meds.

More on Pain Meds

I'm told, by reliable sources, that Percocet has nasty behavior altering characteristics. While it does help the pain, it doesn't necessarily make me a nice person to be around.

During dinner last night, my kids were told "See what drugs do to your father? You don't want to be like that do you?"

What more is there to say...back to Vicoden during the day and the Perc at night.

Why No Smiles?

With all the hardware in my mouth, it's just not possible to smile. On June 4th, that should all change when the arch bars come off. Just 11 more days!!!

Most of the external swelling seems less, with just a little left around my lips and chin. In addition, all the external bruising is pretty much gone. As the bruising went away, it was like watching the fall colors change from black & blue to yellow to ugly yellow, to gone.

Internally, my lips and gums feel swollen. My chin, roof of my mouth, lower lip and gums are still numb and have little feeling. Over the next few weeks the numbness should go away.

Pictures Taken May 23, 2009, 17 Days Post Op

Drugs...

Since the pain in my chin has not improved in the past 5 days, I've switched my primary pain medicine to Percocet.

I really hate the idea of taking stronger, more addictive drugs. However, being in pain makes it harder to get rest, and if I'm not getting rest, I'm not healing.

The Silent Treatment

Since my chin is still hurts quite a bit, I've been told not to speak at all. In all honesty, I had thought that I was doing a pretty good job of keeping quiet. Apparently not. We're now back to the white board and pads of paper. Skype chatting has also been a great tool. I've had a number of phone and video calls. The person on the other end has spoken, and I've been able to respond using the text field. Prettty neat technology...

Since it's a long weekend and the kids will be home, our house will be anything but quiet.

Shades of Gray

I've been told that I don't answer questions. Making my living as a sales person, I tend to answer most questions with another question or a statement that refers to the question asked. However, I rarely provide a direct answer. When I could speak, my communication approach seemed to work out (probably for everyone but my wife). For the past several weeks, however, I've had to change the way I respond.

Here are some examples of how I might respond both before and after:

Q1: How do you feel?

Pre MMA Answer: We had a great ride this morning! Any day in the saddle is a good day. Let's do that again tomorrow.

Post MMA Answer: Fine.


Q2: Are you in any pain?

Pre MMA Answer: When you say pain, how do you mean?

Post MMA Answer: Yes


Q3: What would you like for dinner?

Pre MMA Answer: The salmon you made last night was fantastic! You really out did yourself.

Post MMA Answer: Beef stew.


You get the idea.


On Naps

Today was an improvement over yesterday. My chin is still numb and hurts, so I'm back on Vicoden full time. I also took a 90 minute nap. I woke from my 90 minute nap really tired, but feeling like I had slept. I had that groggy good feeling. Prior to the surgery, I don't remember the last time I took a nap that lasted more than 20 minutes.

Being severely sleep deprived for so long, my body would crave sleep during the day, but would only allow itself short naps when given the opportunity. So if I needed a nap, I could take a five minute nap, and then make it through the rest of the day. Even under the best of conditions, I just wouldn't nap more than a few minutes. Due to the demands of life, work and reality, I rarely took a naps.

Mug Shots...

I had hoped to start this blog with a baby picture. But, being the youngest of four, there just aren't any. Maybe some day I'll get over it...


The first two pictures were taken about a year before the MMA as part of getting fitted for a MAD (mandibular advancement device). I'm 5'9" and weigh 165. For the week prior to the surgery, I ate and ate and ate, bringing my weight up to 172. After a week, my weight dropped to 160, where it has stabilized.

ICU, just a few hours post-op (May 6, 2009)

Day 1 - I figured out how to apply ice and listen to music.

Day 2 - At Home

Day 3

Day 7 - May 13, 2009

The infamous "arch bars" and rubber bands.

And today, May 20, 2009 - Two Weeks Post Op

Due to the arch bars and wax (to protect my gums from the arch bars), my lips are still a bit "pushed" out. This seems more apparent on the "front" mug shots. It will be interesting to see how everything changes in two weeks when the bars get removed.

Managing Expectations

Taking the pain meds helped tremendously. I feel better this morning than I've felt since the surgery exactly two weeks ago today. That's not to say that I'm going to be getting on my bike and riding a century with 10,000 feet of climbing today, but at least I can now see that century in my future.

The emotional recovery is as significant as the physical recovery. There have been a number of different things that I have done to recover emotionally. The most significant was to set expectations.

Prior to the surgery, I wrote down my expectations for recovery:

1. Expect pain and embrace it as part of the recovery
2. Don't judge progress on a daily basis
3. Be thankful and appreciative to everyone, but focus all my energy on the recovery
4. Stay hydrated and nourished
5. Shower and get dressed first thing each day
6. Find a simple way to update family and friends (that's what this blog is about)

There have been a number of times where I have gone back and reviewed my list. It's helped me stay focused and look beyond the challenges of each particular day.

Medication - Or Lack There Of

I'm not a big fan of pain medication. I've always stopped taking pain medication as soon as possible. It inhibits thinking and alters moods. I've felt that the pain medication has slowed recovery from injury since I can't always differentiate the effects of the pain medication from the injury itself. The sooner I stopped taking the pain medicine, the faster I would recover - WRONG!!!

This recovery was no different. A week after surgery, I stopped taking Vicodin and thought that the Tylenol would be sufficient. I was wrong. When updating THE surgeon during the visit today, I described my pain as very significant. He asked what I was taking, and I said just Tylenol. He very kindly pointed out that perhaps I should reconsider my pain killer of choice to something a bit more powerful. He also pointed out that the greater the pain, the harder it would be for me to rest and recover. (As my kids would say - DUH!!!)

I'm now taking Tylenol with codeine and it seems to provide more relief than straight Tylenol. My plan at night is to take the Vicodin in hopes it will contribute to restful sleep. We'll see.

The decision to continue the stronger pain medication should have been obvious, and looking back, I made the wrong decision to stop. But, we are who we are. I expected the recovery to be difficult. On a scale of 1 to 10, I expected a 9. 9 turned out to be about right. I've had other rough recoveries in the past - operations, broken bones, bike crashes, etc. Perhaps those recoveries would have progressed faster by taking advantage of modern medicine.

Note and acknowledgement to female readers: I've never given birth - so any pain I've experienced is relatively minor to compared to "real" pain resulting from having enjoyed that first apple.